Finding one name in a printed list. Checking a bill line by line. Picking the right bus number off a crowded timetable, or a phone number out of a page of small print. Each of those asks the eyes to move across a field of similar-looking marks in an orderly path, pick out only what matters, and keep going until the whole field has been covered. After a stroke or brain injury that kind of scanning can become slower and less reliable, and the misses tend to land in the same places: the end of a row, one side of the page, or wherever attention drifted.
This page is about the letter cancellation sheet: a grid of letters, one or two targets to cross out, and everything else to leave alone. You can download a free moderate-level sheet below (worksheet LCT2A, cross out every B and V), see how the 30-worksheet set is graded from a single uppercase letter through case-sensitive pairs, and read how the format relates to the letter cancellation test used in neuropsychology and occupational therapy, and why a practice sheet is not the test.
Download the free letter cancellation worksheet
Download the PDFWant more pages like this? Letter Cancellation Worksheets (30 Pages) $4.25 See the full set
Worksheet LCT2A from the set, moderate level: 15 rows of 20 uppercase letters, 300 letters in all, with the instruction to cross out every “B” and “V”. There are 26 targets on the page (16 of B and 10 of V), and lines for name, date, number of errors, and time. Free for personal, classroom, and session use.
- Level: moderate (worksheet LCT2A)
- Grid: 15 rows of 20 letters, 300 in all
- Targets: 26 (16 B, 10 V)
- Timing: untimed or self-timed, with a time field on the page
- Paper: US Letter
What is a letter cancellation task?
A letter cancellation task is a page of letters arranged in rows, with one or two target letters to cross out and everything else left untouched. The instruction fits on a single line, which is part of why the format has lasted: it is easy to explain, easy to print, and easy to repeat with a fresh page. The person works through the grid, usually left to right and top to bottom, and the page is scored on how many targets were missed, how many wrong letters were crossed out, and how long it took.
What makes it more than a search puzzle is that the result stays on the page. A skipped target, a distractor crossed out by mistake, and a scanning path that wandered or gave up on one side of the sheet are all visible afterwards. That makes the format useful to a therapist or a family member who is watching for change across weeks rather than reading a single score.
Visual scanning
Moving the eyes through every row in an orderly path without skipping or doubling back. Misses that cluster at the ends of rows usually mean the path broke down, not that the letter was hard to see.
Selective attention
Responding to the target letters and holding back from everything else. On the free sheet, R and P sit close to B, and W and Y sit close to V, so a quick glance pulls the pen toward them.
Sustained attention
Keeping the same care in the fifteenth row as in the first. Compare the top block of five rows with the bottom block; most pages tell their story there.
Spatial attention
Giving both sides of the page equal notice. Cancellation tasks are used to look at visual neglect for exactly this reason, so it is worth noting which side any misses fall on.
The letter cancellation test, and how a practice sheet differs
Letter cancellation belongs to a standard family of paper-and-pencil cancellation tests used in neuropsychology and occupational therapy to look at visual scanning, sustained attention, and visual neglect. The format is decades old: the person is given a sheet of letters and asked to strike out every instance of one target (a single-letter cancellation task) or two targets (a double-letter cancellation task), while the examiner records the time, the number of targets found, the number missed, and where on the page the misses fall. The single-letter and double-letter versions associated with Diller and colleagues are among the best known.
A letter cancellation subtest is also part of the Behavioural Inattention Test, a battery used after stroke and other brain injury to look at unilateral visual neglect, where one side of space receives less attention than the other. In that setting the question is not only how many letters were found but whether the misses sit mostly on one side of the page. The same battery includes a star cancellation subtest, and the free star cancellation worksheet on this blog uses that format with shapes in place of letters.
These tests are given and scored by trained professionals, on their own standard sheets, and the result is read alongside the rest of an evaluation rather than on its own.
Worth knowing: the worksheets on this page borrow the format, not the test. The letter grids are our own, there are no norms, and nothing here produces a score that can be compared with a population. They are structured cognitive practice materials. They are not an assessment, and they are not a substitute for evaluation by a qualified professional. If someone is due to be assessed with a cancellation test, tell the clinician about any practice with this format, since familiarity can affect how a result is read.
How the letter cancellation worksheets are graded
Ten worksheets at each of three levels, all on the same page layout, so only the rule and the field of letters change from page to page:
Basic
One uppercase target per page in a grid of 15 rows of 20 uppercase letters, 300 letters in all. The ten targets are A, E, R, M, Q, B, V, N, Y, and T. One rule to hold, and room to settle a scanning pattern before anything else is added.
Moderate
Two uppercase targets at once on the same 15-row grid of 20 letters. The pairs are B and V, Y and R, O and C, X and B, Q and I, R and Y, Q and P, U and E, S and W, and K and G. Some pairs look nothing alike and some, like O and C, are a near match. This is the level of the free sheet above.
Complex
Two targets with a case rule: one lowercase letter and one uppercase letter, for example lowercase i and uppercase Z, lowercase e and uppercase K, lowercase y and uppercase Q, lowercase j and uppercase I, lowercase n and uppercase S, lowercase g and uppercase P, lowercase r and uppercase T, and lowercase f and uppercase L. The grid mixes upper and lowercase letters and the rows are longer, 24 to 28 letters, so each page holds roughly 375 to 385 letters. The other case of each target is on the page too and has to be left alone.
| What you get | Free sample | Full set |
|---|---|---|
| Worksheets | 1 | 30 |
| Levels | Moderate | Basic, moderate, complex |
| Targets per page | 2 letters (B and V) | 1 letter, 2 letters, then a lowercase and uppercase pair |
| Letters per page | 300 | About 300 on basic and moderate, 375 to 385 on complex |
| Case-sensitive pages | None | 10 |
| Fields for time and errors | Yes | Yes, every page |
| Repeat sessions without reusing a page | One page | Weeks of practice |
Using it in a session or at home
- Set the scanning path before the pen moves. Left to right, one row at a time, top block to bottom block. A finger or a ruler under the current row keeps the place; take it away once the pattern holds on its own.
- Decide about the clock. Untimed is the right way to learn the page. Once the rule is clear, note the time in the field at the bottom and keep it for the next sheet. There is no fixed time limit built into the set.
- Score misses and wrong crossings separately. The free sheet has 26 targets. Count the ones crossed out correctly and subtract from 26 to get the misses, then count any letter that was crossed out but was not a B or a V. Write both numbers down; they mean different things.
- Look at where the errors are, not just how many. Misses on one side of the page, or only in the bottom block, say something different from errors sprinkled throughout. Circle the missed targets afterwards so the pattern is easy to see next time.
- Move up when a page comes back clean. Two errors or fewer at a comfortable pace on two moderate pages in a row is a reasonable cue to try the case-sensitive pages. Step back down if the errors jump.
- Adapt when the pen is the problem. A highlighter or a thick marker needs less control than a pen. If writing is not possible, the person points to or names each target and a partner crosses it out; the scanning is the same, only the hand is different.
Prefer a screen? We also offer a free interactive version, Visual Search on our tools site, which runs a letter or shape cancellation task on screen and reports targets found, misses, and the results split by the left and right side of the display. Nothing to print, free to use.
Who uses letter cancellation worksheets
- Occupational therapists and speech-language professionals
- Hospital, day-program, and community teams supporting adults after stroke or brain injury
- Educators working with adult learners
- Caregivers supporting cognitive practice at home
- Adults looking for structured, printable visual scanning and attention activities
All of our worksheets are designed to be adult-appropriate, visually clean, and easy to understand without unnecessary visual clutter.
The free sheet above is one moderate page of thirty. The full Letter Cancellation set includes all 30 worksheets across basic (single letter), moderate (two letters), and complex (case-sensitive) levels on the same layout. It is also part of the Attention Worksheets Bundle, 165 pages, alongside trail making, cancellation, and vigilance sets, and the attention worksheets guide explains how the attention sets fit together.
These materials support cognitive stimulation and structured practice. They are not medical treatment or an assessment, and no specific therapeutic outcomes are claimed.
